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NPI Code Detail

MEDICARE: LARISSA MARIE POWERS BCBA, LBA

MEDICARE: LARISSA MARIE POWERS BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-24-71925LA

General Provider Information

NPI Number : 1295580637
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARISSA MARIE POWERS BCBA, LBA
Provider Business Mailing Address
First Line : 2000 COVINGTON CTR
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2979
Country : US
Telephone Number : 985-237-1921
Fax Number :
Provider Business Practice Location Address
First Line : 2000 COVINGTON CTR
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2979
Country : US
Telephone Number : 985-237-1921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2024
Last Update Date : 04/22/2024

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